New Indicator Diseases Reveal Hidden HIV

Today, heterosexuals in Europe are at particular risk of carrying HIV for so long that they remain undiagnosed until their immune system starts to fail and they become ill. An international study under the leadership of the HIV in Europe initiative has now revealed that a number of diseases, including herpes zoster and certain forms of cancer, should be on the list of indicators for having HIV -- and thus serve to prompt healthcare professionals to suggest an HIV test to their patients.

The new results and guidelines are to be debated at a major international HIV conference in Copenhagen March 19-20, 2012.

At the HIV in Europe conference we will be discussing how to disseminate knowledge of the new HIV indicator diseases to non-HIV doctors and healthcare professionals across Europe, says Jens Lundgren, co-chair of the HIV in Europe initiative. He's also a professor of viral diseases at Rigshospitalet and the faculty of health and medical sciences at the University of Copenhagen, where he heads the Copenhagen HIV Program, one of the leading HIV/AIDS centres in the world.

Half of all people living with HIV are diagnosed very late in the course of their chronic HIV infection. People infected through heterosexual transmission now comprise 42 percent of these late presenters, as a study of 90,000 Europeans tested HIV positive since 2000 shows.

UNAIDS has estimated that 2.5 million Europeans carry an HIV infection, and as many as 900,000 of these, are still unaware of this. Inside EU the numbers are 800,000 infected with 250,000 undiagnosed.

Ton Coenen, co-chair of the HIV in Europe initiative, director of AIDS Funds and Soa AIDS Nederland suggests that since the HIV/AIDS issue is no longer high on the agenda in many European countries, and since people have to actively choose to be HIV-tested, many perhaps no longer consider going for a test if they have had unsafe sex.

However, the sooner HIV-infected individuals receive a diagnosis and start therapy, the greater are their chances of survival and their quality of life. And new research also shows therapy lowers the risk of passing the infection on to someone else.

The currently situation shows that we need more effective testing strategies and guidelines, Coenen says. More than 300 doctors, healthcare professionals, NGOs and health politicians from 40 European countries will be discussing this need at the conference, so we have the ideal forum for it."

 We already have a list of AIDs-defining diseases, the vast majority of which indicate a weak immune system. This is a symptom of HIV and should lead to an immediate HIV test, Lundgren explains. We nned to find people living with HIV sooner than is currently the case, but to do so requires that doctors and other healthcare professionals offer tests to people presenting with diseases indicative of a hidden and undiagnosed HIV infection earlier in the course of the disease.

The HIV in Europe initiative took up this challenge in 2009 and started the HIDES study (HIV Indicator Diseases Across Europe), which investigated eight new diseases and how often they proved to be signs of an undiagnosed HIV infection among the 3,588 patients in the study.

We could see that if an adult had a sexually transmitted infection, malignant lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B or C, ongoing mononucleosis-like illness, inexplicable, persistent decline in the number of circulating white blood cells, or seborrheic dermatitis/exanthema, the risk of HIV infection was so high that it would be cost-effectiveness for society to routinely offer them a test, Lundgren says. He also emphasizes that the new indicator diseases do not necessarily mean that the patient has HIV.

But the incidence of HIV is greater for these eight indicator diseases and they should encourage healthcare professionals to offer the patient an HIV test. Draft guidelines on how to ensure this throughout Europe are one of the topics we need to debate and decide on, before they can be implemented.